None listed
Conditions
Brief summary
Adolescence and young adulthood (‘young people’) is a time when health-compromising (‘risk’) behaviours such as substance use emerge and sexual activity commences – 1 in 4 will have a mental health condition. The Royal Australian College of General Practitioners Guidelines recommend evidence-based health checks for young people to detect risk behaviours such as substance use, unsafe sexual practices, assess weight and diet, and identify mental health conditions early enough to reduce morbidity and prevent escalation of behaviours. GPs can intervene by counselling, STI screening, referring to dieticians, prescribing contraception and initiating mental health plans. Yet, general practice is failing young people: only 15% have an annual chlamydia test; only 6% are prescribed the most effective contraception, and; only one third of the those with a mental health condition have a mental health plan initiated. Consultation time is the key obstacle. To address this, there are calls for a Medicare rebate to fund a longer consult so that the assessment can done. However, without RCT evidence that such a rebate would be ‘value for the patient’ and ‘value for the health system’, a rebate is unlikely to be recommended. We conducted a cluster RCT to determine whether a rebated health assessment for patients aged 14 to 24 years in general practice is cost-effective. A total of 44 clinics participated and were randomised to receive a rebate payment the same as is available for the 45-49 year check. The primary outcome is detection of risks and health conditions because this is the first step required to get GPs to initiate an action to improve patient outcomes whether this be testing (e.g. STI screening), prescribing (e.g. contraception), managing (e.g. common mental condition), referral (e.g. mental health, dietetics) or education/counselling (e.g. alcohol).We recruited a cohort of 1,523 16 to 24 year old patients from the clinics to collect information about the impact of the health assessment on their quality of life. This information will inform our economic modelling which will investigate the impact of rebates on downstream health outcomes.
Interventions
GPs will be encouraged to undertake annual health assessments with adolescents aged 14-24 years. They will receive one rebate payment for each adolescent health assessment conducted per patient per year for a maximum of two years. It will be an annual rebate because the RACGP and the RACP recommend annual checks for young people. The rebate amount will be based on the MBS rebate for assessments such as the 45-49 and 75+ year checks. There is no minimum requirement for this health check; however,
GPs will be encouraged to undertake annual health assessments with adolescents aged 14-24 years. They will receive one rebate payment for each adolescent health assessment conducted per patient per year for a maximum of two years. It will be an annual rebate because the RACGP and the RACP recommend annual checks for young people. The rebate amount will be based on the MBS rebate for assessments such as the 45-49 and 75+ year checks. There is no minimum requirement for this health check; however, all GPs will be supplied with a comprehensive template for health assessment. The rebate claimed will be commensurate with time taken to undertake the assessment i.e. <30 mins (MBS item # 701) $67.70; 30-<45 minutes (MBS # 703) $157.10; 45-<60 mins (MBS # 705) $216.80 or 60 mins+ (MBS #707) $306.25. This rebate will be administered by University of Melbourne and will mimic the process of Medicare whereby funds are transferred electronically to the clinic on a weekly basis. During the trial, there were two increases in fees, in July 2023 and July 2024, the most recent amount listed above. In July 2023 we had recruited 11 practices and 69 GPs in the intervention group who were able to claim rebates. By July 2024 we had recruited an additional 31 practices, including an additional 23 GP in intervention groups.
GPs were encouraged to undertake annual health assessments with adolescents aged 14-24 years. GPs in the intervention group received one rebate payment for each adolescent health assessment conducted per patient per year for a maximum of two years. It was an annual rebate because the RACGP and the RACP recommend annual checks for young people. The rebate amount will be based on the MBS rebate for assessments such as the 45-49 and 75+ year checks. There is no minimum requirement for this health c
GPs were encouraged to undertake annual health assessments with adolescents aged 14-24 years. GPs in the intervention group received one rebate payment for each adolescent health assessment conducted per patient per year for a maximum of two years. It was an annual rebate because the RACGP and the RACP recommend annual checks for young people. The rebate amount will be based on the MBS rebate for assessments such as the 45-49 and 75+ year checks. There is no minimum requirement for this health check; however, all GPs will be supplied with a comprehensive template for health assessment. The rebate claimed will be commensurate with time taken to undertake the assessment i.e. <30 mins (MBS item # 701) $69.20; 30-<45 minutes (MBS # 703) $160.85; 45-<60 mins (MBS # 705) $222.00 or 60 mins+ (MBS #707) $313.60. This rebate was administered by University of Melbourne and mimiced the process of Medicare whereby funds are transferred electronically to the clinic on a weekly basis. During the trial, there were three increases in fees, in July 2023, July 2024 and July 2025, the most recent amount listed above. In July 2023 we had recruited 11 practices and 69 GPs in the intervention group who were able to claim rebates. By July 2024 we had recruited an additional 31 practices, including an additional 23 GP in intervention groups. We had a final sample of 44 practices.
Sponsors
University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
14 Years to 24 Years
Healthy volunteers
Yes
Inclusion criteria
1) Clinics: a general practice will be eligible if they have (i) at least 600 consultations each year with 14-24 year-olds; (ii) use Medical Director or Best Practice for their electronic medical records software, as these are compatible with our data extraction tool GRHANITE.™ 2) 14-24 year-olds: will be eligible for participating in the cohort study if they are aged 14 to 24 years, are attending the clinic for their own health during the trial and are able to give informed consent to participate.
Exclusion criteria
1) Clinics: If they refuse to allow GRHANITE data extraction tool to be installed on their clinic computer and extract patient consultation data. 2) 14-24 year olds: Unable to provide informed consent (eg: language or learning difficulties); 14-15 year olds whose legal guardians do not provide consent to participate; who do not have access to a computer to complete follow up surveys; who are severely unwell or distressed at the time of recruitment.
Outcome results
None listed